ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 N12

Billable / Specific CC

Tubulo-interstitial nephritis, not specified as acute or chronic

N12
Block
3
Synonyms
12
LCDs
2
Payer Policies
0
Linked CPTs

About ICD-10-CM N12

ICD-10-CM code N12 represents Tubulo-interstitial nephritis, not specified as acute or chronic. This is a billable/specific code in the Genitourinary System chapter (block N12). The 2026 edition of ICD-10-CM N12 became effective on October 1, 2025.

Coding Tips for N12

Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.

Inpatient DRG impact: CC

N12 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under N12. Per CMS ICD-10-CM Tabular 2026.

  • Interstitial nephritis NOS
  • Pyelitis NOS
  • Pyelonephritis NOS

Type 1 Excludes

Pure excludes, these codes can never be coded together with N12. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • calculous pyelonephritis (N20.9)

Inpatient DRG Impact, CC

1328:228 codes Tubulo-interstitial nephritis, not specified as acute or chronic. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.

Medicare LCD Coverage for N12

Local Coverage Determinations (LCDs) from CMS MACs that list N12 as a covered diagnosis.

12 LCDs

Showing top 10 of 12 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74170 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74177 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74160 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74178 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74150 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 72194 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74176 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 72192 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 72193 →
CMS LCD: Billing and Coding: Retroperitoneal Ultrasound
Article ID: 55336, Effective: 2025-10-01 00:00:00, 797 covered, 0 non-covered
CPT 76775 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing N12.

2 policies

2 Medicare

Billing and Coding: Retroperitoneal Ultrasound
Policy ID: ART-55336
Billing and Coding: CT of the Abdomen and Pelvis
Policy ID: ART-56421

CPT Codes Commonly Billed with N12

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

No procedure linkages on file for N12

We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.

Convert N12 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
N12 59080 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 N12, Billing FAQ

Is ICD-10 code N12 billable? +

Yes, N12 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What other names or terms map to N12? +

ICD-10 N12 includes: Interstitial nephritis NOS; Pyelitis NOS; Pyelonephritis NOS.

What codes are Type 1 Excludes for N12? +

Type 1 Excludes (never code together with N12): calculous pyelonephritis (N20.9)

Is N12 a CC or MCC for inpatient DRG? +

Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.

What ICD-9 codes does N12 map to? +

Per CMS GEMs, N12 maps to ICD-9 codes: 59080. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on May 31, 2026.

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